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Posted: 02-Mar-25
Location: Dallas, Texas
Categories:
Internal Number: 25003305
JOB SUMMARY
Texas Non-Subscriber Claims Specialist
Hybrid position located in Dallas, TX: 1 - 2 days per week onsite, 2 weeks onsite for training (more if needed)
- Under the direct supervision of the Safe Choice Claims Manager the Safe Choice Claims Specialist II is responsible for the review, study and processing of assigned claims within their authority limits and consistent with policy and legal requirements. The goal of the position is to provide prompt, efficient delivery of quality service while protecting the assets of the organization.
- The Claims Specialist II primary duty includes the exercise of discretion and autonomous judgment with respect to matters of significant financial impact and confidentiality.
ESSENTIAL FUNCTIONS OF THE ROLE
- Promptly investigate assigned non-subscription claims to assess liability and entitlement to benefits.
- Confirm applicable coverage; maintain compliance w/ERISA plan document, insurance policies and procedure manuals. Take recorded statements, establish reserve requirements, identify subrogation potential, maintain diary
- Review and evaluate medical and loss wages, conduct thorough investigation of the claim through contact with witnesses. Provide status reports to management as needed.
- Resolve complex, severe exposure claims, using high service oriented file handling
- Responsibility for the preparation of summaries and files for denials, appeals, medical advice, subrogation and litigation.
- Collection of documents and summarizing information.
- Providing presentations for committee meetings and any required correspondence.
- Applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio
- Assign surveillance on appropriate claims
- Identifying claims with possible recovery from third parties
- Maintains communication with doctors, attorneys, safety specialist, and nurse specialist and outside vendors to provide prompt, economical and professional handling of all claims.
- Talking to others to convey information effectively
- Communicating effectively in writing as appropriate
- Provide and Coordinate training with HR team
- Work with Claims Manager for improvements in processes to increase proficiency and supervise effective resolution of all claim inquiries.
- Responsible for the approval of lost wages for payroll and for all approvals of medical bills per claim file.
- Pay and process claims within designated authority level
- Performs other position appropriate duties as required in a competent, professional and courteous manner.
KEY SUCCESS FACTORS
- Can substitute Bachelors degree for years of experience
- Texas All Lines Adjuster License, Non-subscription Experience Preferred" - will obtain with one month of hire
BENEFITS
Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:
- Immediate eligibility for health and welfare benefits
- 401(k) savings plan with dollar-for-dollar match up to 5%
- Tuition Reimbursement
- PTO accrual beginning Day 1
Note: Benefits may vary based upon position type and/or level
QUALIFICATIONS
- EDUCATION - H.S. Diploma/GED Equivalent
- EXPERIENCE - 5 Years of Experience